The Opioid Solution and HIV: From the Frying Pan Into the Fire

Information From the USA

In July this year, the FDA instructed companies to cease the manufacture and distribution of certain drugs containing Oxycodone (Oxycontin). These are specifically single ingredient and immediate release drugs, including capsules, tablets and oral solutions. The principal reason for this is the ease with which they can be abused. Crushing a pill and smoking or snorting it will provide an instant high and therein lies the danger for speedy addiction problems.

The idea is that these immediate release drugs will be taken off the market thus nipping the problem in the bud. However, it is a slightly clumsy measure for two reasons: determined addicts will head underground or on the internet for their supplies from other countries and people in genuine medical need will be cut off from their source. The pharmaceutical companies are busy developing new versions of opioids which only have a delayed release effect but the ban came before these were widely available. The word 'distribution' in the ban also meant that doctors and pharmacies could no longer supply their patients with their regular pain relief, thus creating a vacuum which has only increased suffering for many people.

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Apart from the FDA trying to cover their backs in relation to the prescription abuse epidemic, the U.S. Senate ordered an investigation into the pharmaceutical industry and in particular Purdue Pharma, the manufacturers of Oxycontin. Not only that but the investigation extends to their funded pain organisations and physicians who are suspected of profiting from the prescription drug problem.

"Senate Finance Committee Chairman Max Baucus of Montana and Senator Chuck Grassley of Iowa sent letters to Purdue Pharma, Endo Pharmaceuticals, Johnson & Johnson and nine pain organizations, saying "there is growing evidence pharmaceutical companies that manufacture and market opioids may be responsible, at least in part, for this epidemic by promoting misleading information about the drugs' safety and effectiveness."

And from the same article:

"'Improper relationships between pharmaceutical companies and the organizations that promote their drugs can put lives at risk. These painkillers have an important role in health care when prescribed and used properly, but pushing misinformation on consumers to boost profits is not only wrong, it's dangerous,' Sen. Baucus said in a statement."

The official line then seems to be based on sound concerns and we must applaud people who keep a close eye on the workings of the multi-billion dollar pharmaceutical industry but in this case, it doesn't solve the immediate problem. There are hundreds of thousands of people, including many living with HIV, who need their pain relief to get through the day and for genuine reasons. Then there are the many addicts who also can't be cut off without help and some sort of slow weaning-off program. To many people's surprise, this very dilemma has led to a resurgence in heroin use -- these people need something, they can't just be abandoned to get on with it themselves.

Kentucky officials recently began a system of electronically tracing pills and found that there was a pipeline of opioids coming in from Florida. Cracking down on this sort of supply route means that opioid analgesics become much harder to find, even on the illegal circuit; but this also leaves the door open for substitutes such as heroin. The heroin has been traced back to Mexico and Central America and as always, supply and demand runs the show. A single Oxycodone pill can cost between $80 and $100 and a single hit of heroin, with 24 hours working value, can cost as little as $15 to $20! You do the math.

They should really have waited until there were sufficient delayed-release opioid pain killers on the market before removing them from official outlets and cracking down on drugs pipelines; but they didn't, and people addicted for whatever reason have needed to deal with their pain. Heroin, however attractive, is a frightening option and hopefully legitimate patients will never go down that road.

It's important to remember that Oxycontin is by no means the only opioid that has these troubling side effects. Morphine family members -- including amongst others, Tramadol, Dilaudid and Percodan -- all have their own stories of widespread addiction after delivering relief from chronic pain.

The main causes of drug-attributable deaths are suicide, overdose and AIDS contracted from sharing needles - all of which are strongly associated with injection drug use.

Each year, about 1% of opioid users will die from an overdose.

In 1995, opiate poisoning was the cause of about 160 out of 804 drug-related deaths in Canada, and opioids accounted for 11% of the 6,947 hospitalizations attributed to illicit drug use. (This does not include the hospitalizations for inappropriate use of prescription opioids.)

People who are opioid dependent are also extremely vulnerable to life-threatening blood-borne diseases, such as HIV and hepatitis C. Between 1985 and 1999, the proportion of people in Ontario diagnosed with HIV through injection drug use rose from 0.45% to almost 15%. In 1999 alone, injection drug users accounted for 24% of new HIV infections in Northern Ontario and 15% of new HIV infections in Ottawa. As of 2000, 63% of newly diagnosed cases of hepatitis C are related to injection drug use.

In 1999/2000, drug possession or drug trafficking accounted for 7% of new admissions to correctional institutions (2,110 people), 5% of new admissions to probation (1,809 people) and 16% of new admissions to conditional sentences (694 people). These figures do not include the number of people convicted of theft or other crimes to support a drug habit.

The Ministry of Community and Social Services estimates that about 3% of users of the social assistance or welfare system have a history of drug dependency, which affects both their employability and their ability to maintain employment.

It's again important to remember that this paper was drafted some years ago and since then the opioid problem is said to have 'exploded', which if true, is a frightening thought. Whether the problem has really become so much greater since 2000 is open to discussion. The truth may be closer to the fact that the media in western countries has finally cottoned on to the extent of the problem and has devoted column inches to lurid and sensationalist headlines which make it look as though the opioid addiction problem is explosive and threatening to the social fabric.

This and other posts are based on my opinions and impressions of living with both neuropathy and HIV. Although I do my best to ensure that facts are accurate and evidence-based, that is no substitute for discussing your own treatment with your HIV specialist or neurologist. All comments are welcome.

Comment by: T Mills
(Los Angeles)
Thu., Feb. 7, 2013 at 10:42 pm EST
Dave - I recently read a couple of your posts and I believe you have some strong points. As a double-positive myself and a person living with chronic pain from a severe back injury, I would not be able to function without opiates. These are powerful drugs yet we currently live in a country where prescription medications for pain, anxiety, depression, etc have created the largest cohort of drug dependent adults in U.S. history. We lack a progressive approach to pain management. People have been abusing opiates and other drugs for centuries and I think approaching this issue with punitive measures (such as the miserable war on drugs), is not the answer. The media will sensationalize the problem of drugs as there is now a crack down on Human Growth Hormone because of Lance Armstrong when the reality is HGH in many ways saved the lives of many HIV + people like myself when wasting was causing me significant problems. I would be open to inviting a group of medical professionals and pain management experts to the table. I've even thought of jump starting a non-profit to assist persons with HIV/HEPC that is compassionate, realistic, allowing persons with chronic pain who NEED opiates much like the methadone clinics - methadone is in itself an incredibly effective pain killer and despite it's mythology is extremely cheap. (That's probably why the drug companies don't want to push it and the association with heroin addicts.) But as a double positive I take HIV meds and pain relievers daily because for me they save my life and enable me to hold down a job, a relationship, the ability to exercise and to function. I understand your point but the explosion of narcotic pain killers is a bit sensationalized as I think newer drugs will hit the markets and the streets that are more powerful and despite all our efforts people will always abuse anything that makes them feel good. Let me know if you know of any organizations that have progressive approaches to pain. Thanks.

Comment by: nyclic
(nyc)
Thu., Feb. 7, 2013 at 6:16 pm EST
this whole thing irritates me in general. i have had acute episodes of very painful illness in which i needed the strongest thing out there. i am not a chronic pain patient or pain reliever user. removing what works leaves those who are in desperate situations with inadequate pain management. ever had shingles? three times here including facial and into my right ear. felt like an ice pic in my skull. what about those really unfortunate metastatic cancer survivors? can only be worse.

Comment by: Dave
(Flrida)
Thu., Feb. 7, 2013 at 4:01 pm EST
Since my move to Florida from upstate New York I have been faced with the affects that opioid abuse has had on those of us that depend on opioids to have a "normal" life! I have had to use opioids because of the severity of my pain issues for some time now & when I moved to Florida the, "Opioid Abuse Center", I was faced with the inability to find a pharmacy that carried my medications & when I did, I was faced with judgement from pharmacists in turn, causing some delays on getting the meds & having to suffer partial withdrawls more than once. Those that abuse these medications effects the lives of those of us who are trying to have some sense of a regular life & it hurts. It scares me to think of the day when I can't get the medication that works for my pain because of others. I literally have had nightmares about this since my move to Florida & hope that those of us on the medications we need can be protected from an all out ban. I am able to walk & do my artwork because of opioids otherwise, I would be practicaly bed ridden unable to do for myself. Opioids have been a "miracle drug" for me & many others who suffer. Thank you. I just had to say that, thank you again. Dave

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English but living since 1986 in Amsterdam, the Netherlands. HIV+ since 2004 and a neuropathy patient since 2007. I've seen quite a bit, done quite a bit and bought quite a few t-shirts if you know what I mean; but all that baggage makes me what I am today: a better person I believe, despite it all.

Arriving on TheBody.com, originally, was the end result of getting neuropathy as a side effect of the medication, or the virus, or both. I found it such a vague disease and discovered very little information that wasn't commercially tinged, or scientifically impenetrable, so I decided to create a daily Blog and a website where practical information, hints, tips and experiences for patients could be gathered together in one place.

However, I was also given the chance to write about other aspects of living with HIV and have now contributed more articles about those than about neuropathy. That said, neuropathy remains my 'core subject' although one which unfortunately dominates both my life and that of many other HIV-positive people.

I'm not a doctor or qualified medical expert, just someone with neuropathy and HIV who has spent the last few years researching the illness and trying to create information sources for people who want to know more.

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